Provider Demographics
NPI:1598348807
Name:SENDERO PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:SENDERO PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SLP
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:PATIRICIA
Authorized Official - Last Name:CANTARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:940-395-5008
Mailing Address - Street 1:1164 LUMBERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8886
Mailing Address - Country:US
Mailing Address - Phone:940-395-5008
Mailing Address - Fax:
Practice Address - Street 1:34 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7013
Practice Address - Country:US
Practice Address - Phone:940-395-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech